Sylvan House Residential Home

Updated 14 March 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Sylvan House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Sylvan House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. However, a new manager had been in post for five months and was in the process of applying to register with CQC.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed the information we had received about the service and contacted the local authority quality and commissioning teams for their feedback. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

We spoke with the manager and four other members of the staff team. We also spoke with three people who lived in the home and five relatives, about their experience of the care provided. We reviewed a range of records. This included four people's care records and multiple medication records. We looked at three staff files in relation to safe recruitment. A variety of records relating to the management of the service, including audits were also reviewed.

Updated 14 March 2023

About the service

Sylvan House is a residential care home providing accommodation and personal care to up to 20 people. The service provides support to older people and younger adults, including those who may be living with dementia. At the time of our inspection there were 19 people using the service.

People’s experience of using this service and what we found

At the last inspection we identified a breach in regulation regarding the management of risk. At this inspection we found that enough improvements had not been made and the provider was still in breach of regulation. For example, some care plans contained inconsistent information regarding people’s needs, and not all care plans contained sufficient information to ensure staff knew how to support them safely and ensure their needs were met. Checks required to ensure the safety of the building and equipment were not always completed regularly and we saw some risks in the environment, such as fire doors that were not working effectively.

At the last inspection we identified a breach in regulation regarding the governance of the service. At this inspection we found that improvements had been made and the provider was no longer in breach of regulation regarding this, although further improvements were still required. New systems had been implemented to help monitor the quality and safety of the service, but they did not identify all the issues we highlighted during the inspection, such as those relating to fire doors and people’s care plans.

Medicines were stored and administered safely. Staff had completed medicines training and most had had their competency checked to ensure they were able to manage people’s medicines safely. However, some newly recruited night staff had not yet completed their competency assessment and temporary arrangements were in place with on-call staff to ensure people would still receive medicines if they needed them overnight.

There was a newly implemented system in place to manage Deprivation of Liberty Safeguards (DoLS), and the manager had begun making relevant applications for people. Although mental capacity assessments had been completed when necessary, further work was required to ensure these were always completed fully and in line with guidance.

People told us they were happy with the cleanliness of their home and that their relatives were supported to visit the home. There were procedures in place to help manage the prevention and control of infections, such as policies, audits and cleaning schedules, but these could be improved. A planned refurbishment of the home was in process, however there were some infection control risks identified. For instance, we saw visibly dirty chairs in the lounge, chipped wood and the basement required work to ensure the area was maintained safely and in line with infection control guidance. Personal protective equipment was available to staff when this was required to be used.

People told us they felt safe living in Sylvan House. There were sufficient numbers of safely recruited staff available to support people and people told us they received the support they needed, when they needed it. Staff knew how to raise any safeguarding concerns they had. Accidents and incidents were reported, and actions taken to help prevent future incidents when possible.

There was no registered manager at the time of this inspection, however a new manager was in post and they were in the process of registering with the Commission. The manager was aware of their responsibilities and working hard to implement new processes in order to achieve the necessary improvements.

Relatives told us the home was managed well and they were always kept well informed about any changes through meetings, newsletters and conversations with staff. Staff told us they were well supported, could raise any issues with the manager and had regular meetings where they could share their views.

The manager worked closely with other health and social care professionals to help ensure people's needs were met. They were aware of their role and responsibilities and was responsive to the issues raised during the inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 1 March 2022) and breaches of regulation were identified. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found that some improvement had been made, but further improvements were still required, and the provider remained in breach of regulation 12 (Safe care and treatment).

At our last inspection we recommended that the provider review staffing levels to ensure enough staff were available in the event of an emergency. this inspection we found this had been acted on.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sylvan House on our website at www.cqc.org.uk

Enforcement and Recommendations

We have identified breaches in relation to the management of risk at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.